How to Survive New COVID Strains

James Katz MD, MPH
4 min readFeb 21, 2021

Use the Added Safety of Double Masks

Photo by Jelleke Vanooteghem on Unsplash

Humanity is in a race between mass vaccination and viral mutations.

I am doing my part vaccinating Massachusetts citizens for COVID-19. Doing vaccinations increases my exposure to COVID-19. I need to be well within the safe social distance as I explain the risks and benefit. I am touching each patient to administer the vaccine. I have changed to a “Double Mask” for better protection and will explain how they work.

A properly fitting Double Mask is as good as the N95 worn at the hospital.

Covid-19 has become more highly contagious. In addition to the named variants -English, Brazil, and South Africa — there are 20 others under investigation and there will be more. To date, no COVID-19 variant has produced more severe disease. However, the 1918 Spanish Flu virus was circulating in September of 1917, but the toxic avian mutation, which killed 100 million people, emerged six months later. There is no guarantee the next one will not. While we wait for vaccinations, you will need to wear a mask. Until we are confident the current vaccines handle new variants, caution may dictate you wear a mask after your vaccine.

The N95 mask is the gold standard of masks, but it is not a good solution for the general population. They are still a shortage item; they and currently reserved for healthcare workers. The tight rubber bands make them uncomfortable to wear for long periods. They are ineffective with beards. They require daily replacement, which is expensive.

CDC Formula for Double Masking

Picture credit CDC.gov

A Double Mask is as effective as the N95 worn at the hospital.

The CDC tested a surgical mask inside a cloth mask, which is what I wear. They are more comfortable than the N95 and can be worn for hours. Replacing the inner surgical mask daily is less expensive than replacing N95s. You must arrange the two masks to make an effective seal. Here are some helpful hints:

The most frequent place for an air leak is the bridge of the nose. At the top of the surgical mask is a thin, flexible metal insert called a nose wire, which should be pinched to fit the bridge of the nose. If you cannot make a good seal, COVID-19 treating physicians recommend taping the top margin of the mask to the nose. To test top edge fit, put on a pair of glasses and breathe briskly; if the glasses fog up, there’s air escaping the top edge of the mask.

Your nose must be covered by the mask. The anterior nose is the site where COVID-19 multiplies and enters the bloodstream. If your mask does not cover your nose, you need a larger mask.

The vertical edges of the cloth mask should rest firmly against your cheek. If they do not, you can put a half twist in the ear loops or put a tightener near the edge of the mask to bunch the fabric. Both are highly effective.

Picture credit CDC.gov

The KN95 is the Chinese version of the N95. If it fits properly, you will see the mask material move in and out with each breath you take. It is more comfortable than an N95. However, sixty percent of KN95 masks are counterfeit. Consult the FDA’s list of approved masks.

They are also designed for daily use only, so an expensive alternative. Do not layer a KN95 mask with any other mask.

Test the all-important fit of your Double Mask is easy:

1. breathe out to see if your eyeglasses fog.

2. Breath in to see if the front of the mask pulls toward your mouth. If there is excess resistance on inhaling, change the type of cloth mask to one with a less obstructive weave.

I am already fully vaccinated. I continue to wear my Double Mask in indoor spaces occupied by other people. In the next few months, I will include flying on my list of activities, albeit with double mask, safety glasses, and hand sanitizer.

I will continue to wear the Double Mask in any medical setting. A new variant can spread for several months before it is detected. I have enormous respect for Covid-19. I do not know if next vaccination recipient is asymptomatically exhaling a vaccine resistant mutation. Falling transmission rates will justify taking off the mask. I can’t wait.

Picture Credit Moderna

However, we are not entirely out of the woods. Significant parts of the Third World need to be vaccinated. A mutation there can travel here quite easily as extensive air travel returns.

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James Katz MD, MPH

Medical practitioner/investigator who goes where the evidence leads.